Provider Demographics
NPI:1659434744
Name:DUDDING, SUSAN K (CNP)
Entity Type:Individual
Prefix:MS
First Name:SUSAN
Middle Name:K
Last Name:DUDDING
Suffix:
Gender:F
Credentials:CNP
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:9314 INTERLACHEN RD
Mailing Address - Street 2:
Mailing Address - City:LAKE SHORE
Mailing Address - State:MN
Mailing Address - Zip Code:56468-8738
Mailing Address - Country:US
Mailing Address - Phone:218-828-2787
Mailing Address - Fax:218-828-6082
Practice Address - Street 1:11800 STATE AVE
Practice Address - Street 2:
Practice Address - City:BRAINERD
Practice Address - State:MN
Practice Address - Zip Code:56401-7308
Practice Address - Country:US
Practice Address - Phone:218-828-2787
Practice Address - Fax:218-828-6082
Is Sole Proprietor?:No
Enumeration Date:2006-12-19
Last Update Date:2007-07-09
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
MN0086125363LF0000X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes363LF0000XPhysician Assistants & Advanced Practice Nursing ProvidersNurse PractitionerFamily
Provider Identifiers
StateIdentifier IDID TypeIssuer
MN5000001471Medicare ID - Type UnspecifiedFNP
MNP20489Medicare UPIN